Follow-up studies have revealed high rates of neurobehavioral disability among very preterm with 5% to 15% having cerebral palsy,severe neurosensory impairment or both. Moreover, an estimated 50% to 70% of preterm infants with birth weights less than 1,500 grams have later dysfunction, including cognitive, behavioral, and social difficulties that impedeprogress in school and require special educational support. The specific aim of this study is to test the effect of a patterned feeding experience (PFE) from birth to discharge from the neonatal intensive care unit (NICU) and beyond for infants born before 30 weeks gestation. The primary aim is to test the effect of a PFE on neurobehavioral organization at three time points: the transition to oral feedings, NICU discharge, and 2 months corrected age (48 weeks PMA). Secondary aims are to test the effect of a PFE on cognitive function at 6 months corrected age, feeding-related neurobehavioral development, and clinical outcomes, and to describe the potential effects of demographic conditions and biobehavioral cofactors on the outcome variables. A longitudinal, randomized control trial is proposed with two groups, one receiving a patterned feeding experience from the first gavage feeding through full oral feedings to discharge and one receiving usual feeding care experience. The intervention planned for this project is based on principles of neural plasticity and neuroprotection and is designed to take advantage of neuronal synaptic development and both experience-expectant and experience-dependent characteristics of the developing brain. In addition, the intervention is designed to take advantage of a regularly occurring caregiving and life sustaining event in the life of an infant, feeding. The intervention takes advantage of what we have learned about oral feeding experience in our first R01, as well as what we have theoretically hypothesized is occurring in relation to the effect of patterned feeding. Thus, the patterned feeding experience intervention designed for this study involves a continuity of tactile experiences associated with feeding to train and build neuronal networks. Theoretically, this intervention provided at a critical time in neurologic system development and associated with a recurring event (feeding) should enhance neural connections that may be important for later development, particularly language and other cognitive and neurobehavioral organization skills. The proposed study addresses the National Institute of Nursing Research's focus on the interplay of biology and behavior in an effort to promote health and limit disease. Consistent with NINR's goals, the intervention is based on well- defined underlying mechanisms and includes examination of genetic cofactors and other biomarkers implicated in poor neurobehavioral outcomes. Very specifically, the proposed study will investigate ways to ameliorate the long-term consequences of prematurity using a unique intervention that will easily adapt to caregiving the NICU. PUBLIC HEALTH RELEVANCE: The number of infants born preterm has not declined and these infants are at risk for poor long-term outcomes. This study will test an intervention administered during infant feedings that is designed to improve developmental outcomes.